Central Centrifugal Cicatricial Alopecia (CCCA) Hair Loss (2025)

Central centrifugal cicatricial alopecia (CCCA) is a type of hair loss that begins at the top of the head and gradually spreads downward. It is most common in Black women, with a prevalence of 2.7% to 5.6% in that population. Researchers believe the causes may be related to genetics and environmental factors.

How Is CCCA Different from Other Types of Hair Loss?

CCCA is a type of hair loss that is seen in people of any sex and ethnicity but is more common in Black women between the ages of 30 and 55.

Before hair loss begins, the hair can feel scaly with tiny bumps. This may be due to inflammation in the area. The hair loss starts at the top and center of the scalp and spreads outward in a circular pattern.

Some people may experience hair loss without any other symptoms, but when symptoms do occur, they can include:

• Burning
• Itching
• Pain
• Tenderness

After hair loss, the area becomes scarred and can feel smooth and appear shiny. The name of the condition relates to the pattern of loss (central, centrifugal) and that it produces scarring (cicatricial)

Causes

The exact cause of CCCA is unknown. Research has identified both genetic and environmental triggers. In CCCA, inflammation destroys hair follicles, which are pores from which hairs grow, replacing them with scar tissue.

Scientists believe that CCCA may develop when an environmental change to the scalp creates an immune response that causes an autoimmune reaction (in which the immune system mistakenly targets the body's own tissues). Another belief is that mutations (changes) to the PADI3 gene are connected to CCCA.

Research has found several potential CCCA risk factors. These factors do not cause CCCA but have been found to increase the chances of developing the condition. These risk factors include:

• Bacterial scalp infection
• Chemical hair relaxer use
• Pregnancy
• Traction hairstyles (ones that pull on the hair, such as cornrows, tight braids, tight ponytails or updos)
• Type 2 diabetes (cells become less responsive to the hormone insulin, which causes high blood sugar)

Note that many people who have these risk factors do not develop CCCA, and many people who develop CCCA do not have these risk factors. It is also not a contagious condition.

Does Treatment Reverse It?

If CCCA is suspected, the sooner treatment is started, the better. Early treatment can stop hair loss and mayhelp regrow lost hair.

Treatment cannot reverse hair loss when someone is in a later stage of CCCA. Treatment will be focused on preventing additional hair loss.

CCCA is diagnosed by a healthcare provider. You may be referred to a dermatologist (medical doctor specializing in conditions of the skin, hair, and nails). The provider will:

• Closely examine the scalp and hair
• Discuss your symptoms and how long you have had them
• Note your medical history, including medications
• Discuss your hair care practices, including hairstyles

If these lead to a suspicion of CCCA, the provider may perform a scalp biopsy. They will numb the area and collect a sample of skin, which will be analyzed under a microscope.

Treatment Options

The treatment options available will vary based on the severity and stage of hair loss and include:

• Corticosteroid cream: A provider may prescribe a corticosteroid cream for the scalp to prevent additional hair loss. It is applied every day for two to four weeks.
• Corticosteroid injections: Some people may receive corticosteroid injections in their provider's office. These are typically done for six to eight months.
• Antibiotics: Antibiotics may also be used to reduce inflammation. They may be applied to the scalp or taken as oral pills for two to six months, depending on how long it takes to reduce inflammation.
• Calcineurin inhibitor: Another topical anti-inflammatory medication called a calcineurin inhibitor may be prescribed to apply to the scalp.
• Rogaine (minoxidil): Minoxidil can be applied to the scalp once or twice daily to regrow hair. However, minoxidil alone will not prevent future hair loss. It's important to follow the provider's medication instructions for best results.

Outlook, Coping, and Acceptance

CCCA can be distressing and significantly impact a person's quality of life. Quickly identifying, diagnosing, and treating CCCA will increase the chance of hair regrowth.

Talk with a healthcare provider or social worker about finding alopecia support groups. Engaging with people who experience similar health conditions is a helpful way to connect, learn, and cope with the changes.

Summary

CCCA is a type of hair loss that begins at the top of the head and spreads downward in a circular pattern. It is believed to be caused by genetics and environmental factors. Several risk factors increase the likelihood of someone developing CCCA. Early identification and treatment can stop the hair loss and possibly reverse it.